Master Your Thyroid: Navigating Hormones and Health In Menopause

Did you know that women go through thyropause? And thyropause is actually in response to perimenopause and menopause, and it's because we have a hormone symphony. And when our sex hormones in perimenopause and menopause go sideways, so do the thyroid hormones. And today I'm joined by my dear friend Dr. Amy Horniman. Um, if you've heard us before, we do a lot of podcast swaps. She's one of my dear, dear friends. She has a new book coming out called The Thyroid Fix. And what we're talking about today are some very important things for you to understand how to navigate your thyroid symptoms when you have a practitioner that maybe doesn't understand deeply enough or isn't quite listening to you. So we're gonna go through things like how to understand your lab work and how to understand how to address when your practitioner may not be doing just the right thing for you. We dig into conversion of T3, what do you need to know about reverse T3, T3. And if all of this sounds like Greek to you, this is the episode for you to understand your thyroid. So join me today on Menopause Mastery with Dr. Amy Horniman. Oh, Dr. Amy, I'm so happy we're back. For those of you that don't know, Dr. Amy and I are really good friends, and oh my God, we're like sisters from another mother.

Yeah, I think we are. Honestly, we speak the same language.

We do, we do. And We're gonna dig in today because, you know, I think there's so much— there's so much information out there that women hear about thyroid and, you know, books about this and that and all this other stuff. But, you know, quite frankly, when you and I were talking earlier, there's a lot of bullshit in this arena about healing the thyroid and how to do that. And I would say largely mismanaged by medicine as well. And you are an expert in this arena, and especially you now have the Bible of how to do it. So we're gonna dig into it today. So, first, before we get started, what would you say is the most frustrating thing you hear after all these years from women coming to you about their thyroid? What's the thing that's like got your panties in a wad? You know what I'm saying? You know?

How long do we have here? Yeah. No, I would say the main thing is when women are told that they're normal. And I don't care, I mean, they might have seen even a functional practitioner, right? Because I mean, you and I both know There's a lot of functional practitioners out there that are jacks of all trades and masters of none. So, they might even have spent money on a functional practitioner or they've bounced from doctor to doctor in the conventional system and they'll come to me and they're like, "Well, it's not my thyroid because I was told that was fine. That's just normal." And it's like, "Well, I'm looking at your thyroid numbers here and these don't look too good and you just told me that you are gaining weight, you can't lose weight, your hair is falling out, you're constipated, you're anxious, depressed, or even like 2 or 3 of those, that really does connect to the thyroid. Let's look a little bit deeper. If your numbers are all screwed up over here, there's a strong connection. So it's people being told that they are normal and everything is fine. It's not your thyroid.

Yeah. And I know you and I have really dug deep into this. And when you're perimenopausal and/or menopausal, there is an interplay between those hormones, the sex hormones and the thyroid, and everybody overlooks it. They're like, "Well, my doctor said I was normal back when I was 35, so it's, you know, I don't have a problem." Yeah. Exactly. Let's go into that. Let's talk a little bit about that because I don't think that gets said enough.

Well, and this ties into thyropause. So, I talk about thyropause in the book and the definition of thyropause is when your thyroid gland shits the bed after the age of 40 due to fluctuating hormones. So what do I mean by that? As Betty has talked about on this podcast over and over again, perimenopause and menopause is a time of hormonal shifting, hormonal change. Many of you women are nodding your heads going, well, I, I know that. I don't have to be told that, right? It's your hormones are going on this wild rollercoaster ride. And we know this can even start in a woman's 30s, or it can start before that with pregnancy when your hormones are on a rollercoaster ride. But specifically, thyropause is really that time after the age of 40 where we know progesterone's going in the toilet. Testosterone is going to closely follow, if not lead the way, and then estrogen will follow both of those hormones before going in the toilet. Estrogen is going to go on a roller coaster ride. So fun times for a woman. And this is also the time where Hashimoto's will present itself. So, 95% of all hypothyroidism, hypo, low and slow, is Hashimoto's, the autoimmune form. And you're listening, oh, well, hey, how are all these people getting hit with autoimmunity? Well, as you've heard on this show and probably many other places, we are now living in a much more toxic soup of an environment right now, which impacts autoimmunity. We also have additional stressors in our life that quite frankly, we didn't even have 10 years ago. And that stress, the hormonal chaos, then the toxic soup is all just— I mean, it's increasing autoimmunity exponentially. And the thyroid is a very delicate gland to that. You know, your chances of getting rheumatoid arthritis from fluctuating hormones, toxic soup environment, and stress, you know, there's not a distinct connection. There might be, we'd be reaching. But the thyroid is like canary in the coal mine. It's like, what is happening with the body? All right, piss off, lady. I'm going in the toilet now. And it just slows production and it starts to tank. And so then we see the overlay of symptoms. So yes, we have the perimenopause-menopause symptoms. Then we have the low thyroid symptoms. And that poor woman is like, what in the actual is happening with my body right now? Because she's being hit from two different directions, thyroid and hormones together.

Yeah. And I think, you know, it, it's overlooked at the impact of, um, progesterone in calming the immune system and even estrogen. It's like estrogen is like Goldilocks. It either needs to be just right. If it's too high, it's immune stimulating. If it's too low, immune stimulating. And you know, it's, it's just, and so when, when women end up in this perimenopausal zone, it's, you, you need to be looking at all those things all the time to identify if that may or may not be going on and I think that completely gets missed. Alright. So, let's— so, let's talk a little bit about like thyroid, particularly thyroid healing.

Uh-huh.

Right? Because, you know, as somebody that produces products, you produce products, we have products that can help thyroid function like thyroid conversion and things like that. Yup. But I think there is a— I mean, there is an incredible amount of marketing around, you know, fix your perimenopause naturally, hormone balance, you can't, ovaries have petered out. But, there's also a lot of malfeasance in the thyroid space that like taking a couple adaptogenic herbs is going to turn back on thyroid function. And, I think a lot of people get taken and they keep going down this road because they want to do it naturally.

Mm-hmm. Oh, girl. We could just— we could go to town with this. I actually just saw the other day, it was a YouTube ad that came across a video I was watching. And, I normally hit the skip button, but I let it play. Because I wanted to hear what this woman said. She had that hook in the beginning. And I'm like, I want to hear what she— she was selling non-hormone-based perimenopause, menopause therapy, and selling it as if it was— that's all you need. It's the be-all end-all. That is all you need. And I damn near stabbed my eye out because that message is so damaging. To women. We need hormones, and the thyroid is no different. The thyroid gland makes hormones. So, just like Betty talks about on this show, estrogen, progesterone, testosterone, there's also T4 and T3. Those are two thyroid hormones that your thyroid gland produces. Just like we lose our hormone function, we can lose our thyroid function. We have to replace hormones that are no longer being properly made in our body. And that's not going to be an herb, Chinese medicine, a supplement, a food. It's just not going to work. And I know we all want to go the quote unquote natural route. I get that. But actually replacing hormones is natural. And in fact, when you put in the hormone that is missing, you're— in my opinion, it's much safer than stacking 5 supplements that you don't know the fillers in them, you don't know their source. I mean, even if you buy from Dr. Betty Murray Murray Murray, you buy from me, I mean, you're still combining a bunch of ingredients, which in general, I mean, it can be okay, but are you really going to move the needle on your thyroid production of T4 and T3? Probably just a little bit. And I always use this with any patient that we have come into the clinic that says, You know, I just wanna do this naturally. I go, okay, here's the deal. Let's say that you had a child that was just diagnosed with type 1 diabetes and the doctor comes in and goes, you know, ma'am, I'm sorry, your, your ch— child is no longer producing the hormone insulin by their pancreas in adequate amounts anymore. We're going to have to give your child an insulin pump or insulin injections to replace that hormone. Would you then go, "Eh, I just really want to do this naturally, doc. Aren't there supplements that—" He'd be like, "Well, your kid's going to die without insulin. So, are you sure you want to go the natural route there?" Like, no. Hormones are important. Hormones give us life. And, when they are no longer being produced by our body, we have to replace them. And, that is where thyroid— I hate saying medication, but thyroid medication, i.e., thyroid hormone replacement, comes in to save the day. And when it's done in the right way, when it's done in the right dose that works for your body, let me tell you, you will never, ever again say, I want to go au naturel. You're going to be like, you're going to have to take these hormones out of my dead cold hands because I feel the best I have in my life. Yeah.

You know, I, I mean, it's because I said that there's a whole bunch of bravado and ignorance that usually happens when we're younger. And I will be the first to admit when I was wrong. And, you know, because I've been on thyroid for well over 20 years and, you know, originally I was like, my hair's falling out, my eyebrow— like, I have pretty eyebrows because they're tattooed, people. They're not, they're not mine, right? Like, I'm trying, we're trying really hard to get them back. I've already talked about my hair loss journey and all those things, but I tried so hard, so hard to not take medication for my thyroid. I'd take it, try and get off, like, I can't get off of it, right? Because the side effects are extremely negative and Beyond just like hair loss, weight gain, constipation, anxiety, depression, we can also talk about bone loss. We can also talk about loss of muscle mass. Like, there are, you know, mitochondrial function. There are so many impactful places that when you get hormones back on board in the way your body used to make them and they're not now for whatever reason, right? They're the same. And, and I think the thing people need to understand too is when you're using T3 or T4, it's like going to Lowe's and getting a copy made of your hormone key. It's— yes, it is synthesized in a lab, but it's biochemically the same. So essentially, is it natural? Yes, because it's natural to the exact same composition of the chemical that was made in your body. And so, you know, yes, like ashwagandha may help a little bit with like T3 conversion, those kind of things. So does nutrients like iodine and zinc, but But I think it's just that desire to do that is often so misleading that women suffer for a long time because I did it to myself, you know, because I was all hoardy-toidy, you know, Amy. I was like, I won't need medication. And I'm like, yes, I do. Like, okay. And you know, I can't even go a couple of days without my hormones. There's just, you know, I get crazy. I'm like, I'm ready to, like, rip somebody out of the car and beat them up. I get angry when I don't have hormones.

Well, and there's no gold star given out for the person who takes zero medication. You know, it's like everybody likes to announce, well, I don't even take an Advil. I go, well, I do when I have a headache. Like, I will. Absolutely. And there's just— there's no reward for it out there ever. In fact, the negative trophy is exactly what you said.

You're going to be miserable.

So if that's your badge of honor, that you don't take anything and you don't take hormones, but you're living a miserable life, I mean, Where's the fun in that?

Yeah, yeah. Like, why be miserable? Yeah, why be miserable? So everybody, like, don't be mad at your body if you have to take hormones to replace what is no longer being made. It may be one of the best things that ever happened to you. All right, so let's talk about, um, because your book, your book, because I got an advanced copy, I got a chance to read it, and your book absolutely is probably one of the best books, is the best book, the kind of Bible out there to understand medication management around thyroid because I think this is the other reason why women just get pulled into this sort of branding and sales loops on Instagram because their thyroid is largely mismanaged because we look in these gigantic reference ranges. And so, if your labs fall into that, it's like, "Well, we don't care what you feel like. Your numbers look okay." And, I think that that's a huge issue for women especially. Let's talk a little bit about kind of what your doctor gets wrong around medication? Like, what are those? What are the big key themes here? Because it is super frustrating. It really is.

And, and thank you for saying that about the book, because it really does kind of push the, the limits a little bit when we are talking about that medication piece, because it's very important for me to teach the reader to know what they need. And I know we're going to go through that, but just in general, to answer your question, Unfortunately, and this is the reality, in medical school they are taught a very simplistic linear, uh, standard of care for treating thyroid. And it goes like this: you test TSH, thyroid stimulating hormone. If TSH is above a 4.5, which is the standard lab value range cutoff, then you give T4 medication, Synthroid, Levo, You pat that patient on the back, wish 'em luck, tell 'em you'll retest them in 6 months. That is it. Maybe they'll go up and down in your Synthroid dose and your T4-only dose. That is standard of care. Years ago, Betty, I talked to a group of integrative wellness physicians and they were literally moving from conventional care, opening up one of the first integrative wellness clinics in Erie, Pennsylvania, because we did not have any of that in that little podunk town. And, I'm talking to them about proper thyroid testing. I'm talking to them about being in the Synthroid box. So, exactly what I said, why don't we test beyond TSH? There's free T3, there's free T4, there's the antibodies, there's reverse T3 that I talk about in the book as being one of the most important markers. And then, we go over here and you're putting everybody on the same med. When we have T3, we have Armor Thyroid, we have NP Thyroid, we have Ren, We have all these other options. And guess what? We could combine those options too. We can even take natural desiccated thyroid like Armor, put some T3 with it, like, oh, look at that, mind-blowing. I said, why are y'all in the Synthroid box? And then one doc raises his hand and goes, it's all we've learned. And I was like, well, thank you for being honest, but that is proof positive that that is literally all they are learning in med school. It's funny, I actually wanted to quote my sister who is one of the top geriatric physicians in the country on what she learned about the thyroid in med school and she wouldn't give me a quote. So, it's that bad. It's that bad.

Yeah. Yeah. I mean, even in my own thyroid journey working with functional people, I always joke that I've been on the wildest dosing ride all the way from from, you know, 1 grain of, you know, Armour thyroid up to like 135 micrograms and then back and forth compounded this, that, whatever. And I have landed on an NP thyroid with, you know, with T3, yeah, compounded T3 multiple times a day. And that seems to work really, really well for me or I could do a sustained release either way. But, at the end of the day, it took a lot of playing around to get there. And if your doctor's not willing to meet you where you're at and look at those lab values and also let you try on different, different dosing strategies, you're kind of left to your own. And I think most women get stuck and they feel like they're just banging their head against the wall because the doctor's not willing to talk to them about it because they absolutely just don't know at all what to do.

Yep, yep, exactly. And that— and your story is perfect. It just shows how nuanced and how personalized thyroid optimization really is. There is absolutely no one-size-fits-all. There's no chart to go by. There's no bucket that you fit in. It literally is this beautiful nuanced art in finding what works for your body, just like you had to go through a bunch of iterations to find, okay, this is the combination.

Yeah, it's interesting because even being on like NP Thyroid, like as I dosed up and dosed down, it was crazy. I'm, you know, doubling, tripling the dose. I don't get any heart palpitations. I don't get sweaty. I don't get hot. If anything, I'm still cold. But you check my T3, and this is probably true for a lot of women, you check my T3 and I guarantee you every time it was 2.6. I was like, "Okay, I have quadrupled my dose and it was 2.6." And it was because I genetically don't convert. The amount that was in that was in NP, even though it was statistically similar to what our body should be producing, still was inadequate. Yep. Yep.

And I'm so happy you mentioned that because I do talk about that in the book. I also am a non-converter. I have, I think, one snip on the DIO1, DIO2 pathway. I can't remember. But yes, I mean, there are people that just flat out do not convert. And then, so in that case, I'm on T3 only. Like, you can't even give me T4. Like, no, I will gain weight and go clinically depressed in a week. But it also takes someone who is open-minded enough to understand that, to understand that some people just don't, and they might need T3 only, or maybe we need T3 only for a little bit to bring down the reverse T3, and then we can experiment with adding in T4. But exactly that, that conversation alone just shows the listener how beautifully personalized the thyroid can be.

Yeah, yeah, yeah. Let's, let's go into a little bit about reverse T3 because I know if somebody's seeing conventional physicians, they're not getting it done. And if they are getting it done by a functional practitioner or they order it on themselves or whatever, they may not understand the nuance of what that actual hormone is, you know, and, and how to interpret it against their symptoms and their other lab values. I think that's missed even in the functional community.

Oh my gosh, it really is. I mean, there— I have seen patients come in with labs from a functional practitioner that didn't even include reverse T3. I'm like, are you sure they're functional? Because they should just go back to family care, honestly, just Just go back. So, anyways, reverse T3 is basically the anti-thyroid hormone. So, the only thing, the only hormone that can convert and become reverse T3 is T4. So, I always like to give this analogy, this picture. Picture T4, whether it's the T4 that your body is making, your thyroid is making, maybe it's the Synthroid or the Levo that your doctor gave you, or like Dr. Betty Murray Murray said, it's the NP or the Armour. That your doctor gave you as well, which is 80% T4. So, that T4 has two paths that it can go down. It can go down the path and become free T3, the active thyroid hormone. That's what connects to your cells. That's what turns on your metabolism, gives you the hair growth, gives you the energy, lets you poop every day, all the beautiful things. Or, it can go down the path of becoming reverse T3. And reverse T3, I've wanted to do this AI analogy for like the next talk that I give, and I just have this pictured in my mind where, you know, reverse T3 and free T3 look very similar to each other, but reverse T3 is like this, like ugly Frankenstein looking thing, right? So it looks similar. It can fake out a cell and attach to it. But once it attaches, it doesn't do anything. It doesn't turn on your metabolism. It doesn't light your brain up. It doesn't give you more energy. It doesn't let you poop every day. In fact, it stands there and tells the T3 that's in your system, yeah, you're, you're not connecting today. You're not going to connect to this cell. Forget about it. And the reason I love giving that analogy is because when you ask your doctor, can I have reverse T3 tested? Their answer is usually, "We only test that in a clinical setting." Now, what do they mean by that? They mean if you're in the ICU or the ER, you just came in 'cause you were in a car crash and you're lying there fighting for your life, they'll run a reverse T3 and we hope to God that it's high because that's your body's built-in survival mechanism. Your body knows that when you are injured, Reverse T3 goes up. Now listen to this, 'cause this connects it all. Reverse T3 goes up because it knows at that point in time, you don't need to lose weight. You don't need to make major decisions. You don't need your hair to grow. You don't even need to poop every day. You need to lie there and survive. So all energy in the body needs to be shuttled to healing and survival. Here's the problem. What if reverse T3 is high when you're walking around trying to live life, take the kids to school, run a business, be a good friend, mom, whatever? And you literally feel, or your body thinks, that you're lying in the hospital fighting for your life. That's why you can't lose weight. That's why you can't think. That's why you have no energy. That's why you're constipated. So, we need to know what your reverse T3 is outside of a clinical setting, not inside the clinical setting. We need to know what is it when you're walking around trying to live life. And what this tells us is it gives us a little bit of a roadmap to look deeper. So, what is driving up that reverse T3? What's getting in the way of that T4 to T3 conversion? And we can look at things like stress and insulin and estrogen dominance and nutrient deficiencies and genetic markers. But at the end of the day, if someone is given T4 only, which is standard of care in conventional medicine, or if someone is working with someone that doesn't know the nuances of thyroid and maybe they are put on natural desiccated thyroid, Armor NT, and that dose is, you know, too high for them because it's 80% T4, that can create a reverse T3 problem. And that's where we hear— I mean, we hear our patients say, come into the— to our clinics and say, you know, yeah, okay, I'm on NDT, you know, my last integrative practitioner put me on it. But I just still don't feel well. And then you test the reverse T3 and you say, well, yeah, your reverse T3 is like a 20. You're not converting very well. Your body's in hibernation mode. It's literally thinking that you're lying there in the ICU fighting for your life. And that's the problem. So from there, we can address the things that drive up reverse T3, but we can also adjust thyroid hormone replacement to allow the body to convert better, give the body the active thyroid hormone that it needs. Bring down that T4 a little bit and really balance the person out. So again, moving that person toward the optimal state where they do feel great.

Yeah. You know, I think there's also because, you know, I know this research early on in reverse T3 was kind of especially in the geriatric community because it's like as you get into those later years, which I'm not even going to pretend ever happens, as you get into those later years, we start to see that sort of climb as you see TSH climb, you see a lot of things climb. But, you know, I also saw particularly when intermittent fasting became very, very popular. I intermittent fast. You know, lots of people do it, but I think a lot of people were doing it inappropriately and stressing their body out. We would see these, you know, much higher levels of reverse T3, but they're like, "I have to fast 24 hours a day every day," or, you know, "I have to go 20 hours," or, "If I eat anything—" Like, their diet became more and more restricted. And I'm like, "Because your body thinks it's starving at every moment." Reverse T3 is one of the harbingers of that. Yep. You know, so I think a lot of times we could be self-inducing this and even exercising too much. I don't know if you've seen that, but I've seen when somebody's just got the pedal down and they're just doing too much, not getting that recovery, that reverse T3 will climb. Absolutely.

Or if, if a woman is in that state of maybe being misdiagnosed or not treated properly, what is she going to do to get that annoying weight off that just won't come off no matter what she does. She's going to over-exercise. She's going to under-eat. She's going to over-fast. And all of those 3 things are driving up reverse T3, essentially making her whole situation worse, making her thyroid actually produce less thyroid hormone. But she's in desperation mode. And I get it. I get it. You don't have an answer, so you do whatever you think is going to move the needle, but it's actually making it worse.

Yeah, no, you're absolutely right. Oh my goodness. Yeah, yeah. And I think that's why your book is so valuable, because it helps somebody understand, like, with their own labs and their own behaviors, how to, A, have the conversation with their provider and understand how to change their medication, but also how to address some of those diet and lifestyle pieces that they might be either getting the wrong information, or what I often find is they're cobbling together parts of information and making their own personal protocol. From the things they like from multiple places.

Yes, that too. Yeah, that is true.

Myself being guilty of that, like, I like what she said about this, but I don't want to do that part that she said, so I'm going to do this piece over here, you know, and not recognizing that we might be driving some of our own problems, right? You know, like, I, I often say, until I was able to get my airway fixed and get my sleep dialed in, I could have played around a lot with, you know, whether it was intermittent fasting or, or different dietary things, but my body was not going to respond properly until I got that corrected, no matter how many times I cobbled together somebody's recommendations. Yes, exactly, exactly.

And you know, you alluded to this earlier, and I just want to bring it back up too because something you just said triggered in me. When we, when we do talk about the thyroid, I know, you know, we, you and I both tend to talk about the symptoms that weigh on a woman's mind: the weight, the hair loss, right, the loss of your eyebrows, um, even just the fatigue, like, oh, I can't even get through the day, I don't want to get dressed, everything is tight, I don't want to be social. So it starts affecting social life and, and relationships. I think we forget about the fact that it does affect our heart, our, in our entire cardiovascular system, our brain, and even our immune system as surveillance for cancer. So I don't wanna say like, well, if you have a thyroid problem, you're at an increased risk of cancer. No, but, but since the thyroid does have an impact on every single system in our body, and if we are not on the proper thyroid hormone replacement, let's say you're on T4 only and your reverse T3 is high, nobody's addressing it, nobody's testing it. Does that suppress the body's ability to fight? Those mangled cancer cells, essentially. Yeah. So there is that indirect correlation. There's an indirect correlation to Alzheimer's and dementia. So we're seeing, you know, as women— and I can speak for it because I am one— we look at the now. We don't necessarily look down the road unless you're actually like faced with something that you have to look at. You know, soon, like a cancer diagnosis. But I'm not thinking heart disease. Oh my God, that's for old people. You know, to your point, like, I'm not going to get old. That's for old people. Doesn't that happen to people like older, like my dad?

You know, that's where the symptoms appear, but the actual progression of disease is occurring right now. It's in your 40s, 50s, and early 60s where dementia is actually doing its damage and cardiovascular damage is occurring. And bone loss is occurring. I mean, you and I, I mean, you know, because you followed me through my mom's experience because we're such close friends. And, you know, walking into a nursing home or assisted living and seeing all these poor women in there who are either frail and fragile and have no mobility of their own or dementia or those other, you know, all those other things. My mom being in there because of a stroke, you know, it's not sexy to talk about those things. Right now because we all, you know, I tell people we relate to J.Lo aging. Like, I'm like, don't give me images of what AI is going to say midlife is, which looks like, you know, Flo from Mel's Diner. I was like, I want, you know, I was like, I relate to J.Lo. Yes. But, but the other thing is, is to be J.Lo, we have to live like J.Lo. And I promise you, I don't know J.Lo, but I guarantee you her diet, her food's dialed in. She's got somebody paying very close attention to her, her biomarkers and helping her. Because the way to stay out of those nursing homes is to do this stuff now. And that's not super sexy, but this is game time, right? Yeah, exactly.

And I mean, you talk about it with hormones and we all talk about it with hormones being so key to the prevention of heart disease and Alzheimer's and osteoporosis. But we also have to bring in the thyroid hormones into that conversation because they're just as important.

Oh, totally. Totally. I mean, that's what I— I'm very frustrated by the, the menopause sort of movement online. I mean, I appreciate only 7% of women are actually getting treated for perimenopause and menopause, but it's either being sold like, well, just take an estrogen patch so your symptoms go away, you're perfectly fine, or, you know, that you don't need to be tested, or nobody needs to look at those other things. I was like, no, no, no, no, you need to look at all of it, and it needs to be— it needs to be mapped out, addressed, and then monitored along the way. Yeah, so I completely agree. So, so tell me, so if— so if a woman is listening to this and they're like, okay, I'm probably not being treated properly and I don't, you know, I don't really know what to do, what are some of the things that they would absolutely see in, in the book that they are not gonna see anywhere else? Because I think this is really important. Like, yeah, we had a conversation about not eating gluten if you have Hashimoto's, and you've probably read that you need to eat more vegetables and make sure you get protein and la la la la la, right? Get some zinc. What, you know, let's talk specifically about what some of the things that they can understand in your book that they will never see anywhere else.

That is really the, the lessons to get you to understand how to read your own labs. And I promise it's not that hard. You can do it. The book takes you through it. And then knowing exactly what thyroid hormone replacement type, dose, the whole deal that you need to be on. And I know that's, that's like, oh wow, is that knocking on the door of crossing a line in the medical community? I don't know. I always joke, I say doctors' buttholes are gonna be puckered up with this one. But the reality is, is that we are all smart here. And just because somebody went through medical school training, I mean, Betty Murray and I have a boatload of, of student loans that we're happy to share with y'all. If you want to know how much time and effort it takes to learn all this. But at the same time, I know you and I would never postulate ourselves to be smarter than our listener. Our freaking listeners are smart. Our audience is smart. And you bet your ass that they can learn this and they can stand up for themselves and know exactly what they need. And here's the thing, not every person can work with us in our clinics. So, we need to give them the tools so that they have a fighting frickin' chance out there in the conventional world to stand up for themselves and know exactly what to ask for, how to screen a doctor even before you step foot into their office or give them your copay, or God forbid, give them thousands of dollars if you're going the functional route, what to exactly look for, how to screen them, and then how to have that conversation when you're in there. Because guess what? You already know what your body needs. You just have to simply ask for it and have somebody facilitate it and oversee and guide you a little bit. But, you know, even if they won't guide you, that's all right. The book has you. You're going to be able to guide yourself and know when those changes, when those levers need to be pulled a little bit to tweak your thyroid hormone replacement. Through your labs, through your symptoms, you are going to know because y'all are that smart. Don't underestimate yourself in this area.

Yeah. So, let's talk about one thing that I know you talk about in the book and that I know people get wrong all the time and it screws them when they go talk to their doctor, timing of labs and timing of dosing. Oh my God, all the time because the doctor's like, "Oh, you look perfect." I'm like, "Oh, that hour before you got there, did you take your thyroid?" Oh, I know.

Well, you and I can actually look at a lab and go, Susie, you accidentally took your thyroid, didn't you, that morning?

Yeah, yeah, yeah. All the time. Yeah, you did.

Yes, you did. So, you know, this— I mean, I don't know why this drives me bananas like it does, Betty, but it just does. So there are practitioners out there online telling people to take their medication before they go for their lab. Now, here's the problem. If you're on T4 only, I'm sorry, first of all, that's not going to work for you at all. But, if you are on T4 only, you can probably get away with taking it. It's not really going to mess up too many things. It's still a good idea to hold it, but whatever. If you forget and take it that morning, not a big deal. If you are taking any amount of T3, even if it's a little baby dose of liothyronine, if it's natural desiccated thyroid which contains 20% T3, If you're on a compounded, if you're like, "Well, I'm on compounded thyroid medication." Well, that probably contains T3. T3 is very fast-acting and it actually peaks at the 4-hour mark. So, it's going to peak and then come down the other side. You go, "Well, is it— then is it out of my system entirely?" No, some of it hangs out, but just enough hangs out that if you test 18 to 24 hours after taking your last dose, of a thyroid medication that contains T3, we'll get a nice accurate read. That's where you said, you know, you keep getting a 2.6. That is tested at 18 to 24 hours after your last dose. If you take your T3 and then go to your lab, your T3 is literally in your bloodstream and it's starting to peak. So we draw that lab and we're catching the T3 hormone that is in your blood. We just drew your blood. The T3 that you just took is in your blood, now we are going to get a much higher result. And here's the thing. There is— we have an optimal range that we go by per functional medicine standards that we say, okay, this is where you are going to feel your best with your free T3, with your reverse T3, with your TSH, with your estradiol, with your testosterone. We have that optimal range where we go, you know, this is the bullseye. There is no optimal range anywhere in any training program for what your free T3 should be after you take your medication and you're testing at the peak. And in addition, that number is going to be wildly different based on your dose. So, if you have someone, and I've seen this happen, and I've tested it on myself. So, me personally, I take 50 micrograms of T3 twice a day. If I test in the morning, my free T3 is going to come back incredibly flagged high, like bells and alarms are going off and endocrinologists are having heart attacks looking at the result of a 16 tested at 4 hours after I take it. Now, I've had patients that, oopsies, I took, I took my medication and then drew to, drove to the lab and they come back on, let's say, 10 micrograms of T3 twice a day. Their free T3 is a 6. So, who's right? Who's right? Who's optimal? For all the practitioners out there that say, "Take your thyroid medication and then test 4 hours later," where is optimal? It's not written anywhere. I haven't learned it, haven't seen it, haven't read it. And, if the results go from a 6 to a 16, who's right?

Yeah. Yeah. I mean, occasionally, we'll do that, but I think for the most part, what you want is the trough. Where does it go down to? Yeah. Which is that 24-hour later sort of number to see what happens, you know, because it is a moving target. T4 is such a longer acting— I forgot, it's what, like a— what's the half-life, like 7 days, something like that?

Yeah, 7 days. Yeah. Yeah.

So, it's such a long half-time, but half-life. But, you know, I think the challenge there is, you know, those reference ranges, even the ones that we're looking at and even the functional ones we've taken from the initial references. Are not necessarily accurate. I think it's important to, you know, take all those symptoms, take the labs that you see, and make sure there's no major suppression going on of TSH because it can affect bones over time, you know, especially thyrotropin has a, has a lesser degree activity on bone building. But I think it's understanding that all of those things go together and we have a long way to go to just have some blanket statement that everybody's going to be the same dose. Right.

And, if you're testing, if they're in your clinic and you are testing at the peak just maybe even for shits and giggles just to see what they come back at, fine, because you're not going to look at it and go, "Oh my God, Sally, you're hyperthyroid." But, if you do that and you're not with an experienced practitioner that knows the thyroid, they're going to tell you that you are hyperthyroid, and they are going to drop your thyroid medication when you finally feel good. They're going to drop it because of those numbers. They're going to freak out. And that's the danger. It's totally different if they're working with somebody knowledgeable.

Yeah, that is very, very true. And let's face it, hyperthyroid often has some very noticeable symptoms— sweating, palpitations, you know, heart racing, anxiety. Like, all of those things are clear signs. Weight loss maybe being one of them, but usually you get all those other signs long before you see any of that. Yep. And, um, yeah, and I just think there's, there's just so much there. So, so if we were to kind of sum up all the things that people need to understand in your book, number one, it's how to understand their labs, how to navigate, even if they're with functional practitioners, how to navigate getting optimized there because there's still a lot of misinformation out there. And then what would you say the last thing is? What is the thing that, that, that she absolutely needs to know about your book?

The last thing is what it's not. I mean, yes, of course, we touch on nutrition. You can get that anywhere. We touch on the biohacking tools, which ones are, you know, hold some weight and could actually be beneficial to your thyroid. Things like red light, even microdosing GLP-1s. We talk about that. Absolutely. But what it is not, it is not a recipe book. It's not a diet book. It's not a workout book. You're not going to get, you know, 20 pages of, of paleo recipes in there. It's the nuts and bolts. It's that raw conversation that we would have if you were sitting in front of me, we were sitting down for coffee, you were telling me all of your symptoms, and I was literally talking you through it. Well, Sally, okay, do you have labs? Let's look at them. Okay, what medication are you on? Okay, let's change that up. Now, let's look at all the other aspects of your life that can help support, even some supplemental support, biohacking support. But I want your listeners to understand exactly what you said in the beginning. This is the thyroid Bible. This is A to Z. Literally, there's nothing fluff in it. There's no, you know, sprinkling fairy dust like we said earlier. There's none of that. It is raw and real. Like, this is how you heal yourself. Now, are there some people that fall into the We can heal this naturally category. Yes, but very few. Now, you might be in that category if you're like, I don't have a lot of symptoms. My numbers are starting to change a little bit. A few antibodies are showing up. My mom had Hashimoto's, so that makes sense. Sure, we can catch that early and address it. But I am telling you, if you have symptoms that are debilitating your life in any way, shape, or form, then this book is for you because it's going to be the most real, honest, raw book you have ever read with absolutely no bullshit in it. It's going to be you and I sitting down for coffee talking about your thyroid.

Yeah. Yeah. So, for everybody listening, we're going to have links in the show notes to go get the book. And then, there's a whole bunch of benefits if they jump on that link. You have a bunch of freebies that are awesome.

Oh, gosh. Yeah. We absolutely do. In fact, on May 15th, we are doing an, uh, basically an all-day live event. We're going to be doing giveaways. We're gonna be bringing guests on. You can ask your questions live to me, live to the guests. We're gonna be doing lab reads. It is going to be a day full of fun, and you get a VIP ticket with every single book purchase. We'll send you the link to join us live in addition to being entered to win a year's supply of Thyroid Fixer. A program with me. I mean, just all kinds of fun stuff. So, definitely check out thyroidfixbook.com.

Yeah. So, they can definitely attend that entire live event so you can absolutely enjoy all of that. And, Amy, you know what? I always have so much fun talking to you. I know. So much fun. And, we did an F-bomb. That was amazing. How did that happen?

I might have said one. I don't know.

I think we made it without actually saying, "Fuck it." So I think it's okay. I think it's okay. So, so for everybody listening, we'll have it in the show notes. Make sure you go out there before the 15th of May so you can take advantage of that entire live event. Even if you can't make the whole thing, just show up for what you can, because obviously that's a huge benefit. And then, um, we'll have that all available for you. And then, Amy, thank you so much for being on Menopause Mastery.

Thank you. I love hanging out with you. Anytime. Anytime. Thanks for having me. Anytime.

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